When we are young we take our balance and coordination for granted. Yet as we progress through the years sometimes our muscles get weaker and joints get tighter and our posture changes all contributing to decreases in balance skills.
Osteoarthritis (OA), the most common form of arthritis, affects some 27 million adults per year and is on the rise. The Centers for Disease Control and Prevention (CDC) estimates that in 2005, self-reported arthritis or other chronic joint symptoms affected approximately 21.4 million Americans aged 65 years and older. This estimate is expected to reach 41.1 million by 2030. Osteoarthritis makes simple movements and activities of daily life painful and difficult to perform.
Osteoarthritis typically occurs in the hands, knees, spine and hips affecting a multitude of joints. Those affected with OA will typically complain of symptoms of stiffness, low-grade inflammation and pain. This stiffness and pain are most prevalent in the morning which improves with activity and as the day progresses.
The cause of OA involves a combination of mechanical, cellular and biochemical changes. The processes involves changes in the composition and mechanical properties of the articular cartilage. Cartilage is comprised of water, collagen and proteoglycans, In healthy cartilage, there is continual remodeling that occurs as chrondocytes (cartilaginous cells) replace macromolecules that are lost through degradation. In Osteoarthritis, this process is disrupted leading to degenerative changes and abnormal repair response. 2
Despite increasing awareness of the negative effects of obesity on health and OA in particular, the prevalence of individuals who are overweight or obese is increasing. Data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2000 show that 64.5% of the US population is overweight, including 30.5% classified as obese. Carrying extra weight places biomechanically places increased stress and force on the weight bearing joints. Other common risk factors include joint injury, mechanical stress, history of immobilization and trauma.
Medical Management
Arthritis treatment first begins with education. Treatment for osteoarthritis can help relieve pain and stiffness, however the condition can progress. Physicians will tend to focus to help those afflicted with OA by helping patients manage their pain. There are several ways to do this. The first commonly used approach is pharmacologic intervention. Traditional non-steroidal anti-inflammatory drugs(NSAIDs) have been shown to be effective for OA pain, and are perceived as second-line drugs for the treatment of mild to moderate OA.
Physical therapy is very effective in helping those suffering with OA. Where the focus is on helping the patient by improving their muscle flexibility, joint mobility and strengthening the weaker hip musculature. Resulting in improved mobility, function, decrease pain and improved quality of life.
Because arthritis is a “process,” the most effective training is education and prevention. From a cardiovascular perspective, a cardiovascular program should be tailored to the client. A recumbent or stationary bike is a great starting point to reduce the load to the hips and knee which can be progressed to the elliptical machine. Stretch the tight (postural) hip flexors and quadriceps seen in figure one will reduce the load to the knee joint. Yoga can also be an effective intervention which will improve flexibility, balance, strength and body awareness. Strength training should focus on targeting the weaker phasic muscles; glute maximus, glute medius/minimus as seen in figure two. These muscles are necessary for everyday movements such as arising from a chair, climbing stairs, and negotiating uneven surfaces.
Strengthening the core begins with simple exercises such as bridging with the ball (figure three), targeting glute maximus, hamstrings, and the lower back musculature. This can be progressed to having the client hold longer or to perform a single leg bridge. Functional strengthening exercises such as reverse lunges holding a medicine ball that can be progress to either holding overhead or adding trunk rotation will do two things. four and figure five). The use of aqua therapy can also be effective which eliminates gravity resulting in a client’s ability to strengthen their lower body in a relaxed environment.
Arthritis continues to affect many individuals for various reasons. One thing is certain, knowledge, prevention and early screening is fundamental. Understanding the pathological process and medical approach is the first step in helping your clients with OA. Refreshing yourself on anatomy, biomechanics and understanding proper exercise prescription is fundamental. Any exercise program should be individualized resulting in improved function.
Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, C-IASTM, NASM CPT. Chris is the President of Pinnacle Training & Consulting Systems, LLC. A consulting and education company that is committed to creating and providing evidenced based educational material in the form of home study courses, dynamic live seminars, mini-books, DVD’s on the areas of; human movement, fitness and rehabilitation with unique practical application. Chris has 20 years clinical experience having worked with primarily orthopedic patients, spinal injuries, post-surgical conditions, traumatic and sport specific injuries and 20 years as a personal trainer. For more information, please visit www.pinnacle-tcs.com.
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As a fitness professional or caregiver, what are you doing to help reduce the risk for falls? You may be reinforcing the importance of exercises that promote strength, balance, flexibility, and mobility, but are you aware that decreasing fall risk requires a multi-pronged approach? It’s time to reimagine what we know about reducing falls to better serve our clients of all ages and fitness levels.
Are you aware of these crucial fall risks and are you infusing these fall prevention best practices?
What is proprioception? Proprioception is the ability of your muscles and joints to determine where they are in space. The proprioceptive nerve endings in the body provide us with the information of where our hands, arms, and legs are in space without having to look at them. 1
Proprioception results from sensory receptors in your nervous system and body. Most of these receptors are located in your muscles, joints, and tendons, and when you move, the
receptors send detailed messages to your brain about your positions and actions. Your brain processes these messages and works with your vision, nervous system, and vestibular system to create your perception of where your body is and how you’re moving.2
As a fitness professional, it is important to address coordination and balance issues through various modalities when designing a movement session. For example, incorporating proprioception specific movements will not only reduce muscle deterioration, but also reduce risk of injuries from falls.
Have you tried these?
“In older people who had no signs of disease that would make them prone to falls, higher levels of activity in the front of the brain, called the prefrontal cortex, were associated with a higher risk of falls later in life.” 3 The prefrontal cortex, the area of the brain where goal setting and decision-making takes place, is just one part of the brain that has been linked to fall risk.
These exercises help to light up the prefrontal cortex and other parts of the brain responsible for improving reaction time, coordination and balance.
In a 2015-2018 study by the CDC, “US adults drank an average of 44 ounces” of water, well below the recommended amount of fluid intake for a day. 4 As a fitness professional, being aware of the risk for dehydration is the first step to averting it. While dehydration can have serious mental and physical consequences, it is important to know that it is both preventable and treatable.
Many people, especially seniors, resist drinking a lot of water because they worry about falling if they have to take frequent trips to the bathroom. In fact, dehydration may even occur due to the fear of falling if they worry about getting up multiple times at night.. Whatever the
reason, having an ongoing conversation about hydration should be built into your daily programming.5 You have the ability to ease their fears about increasing hydration to reduce falls.
Are you asking these questions?
Perhaps one of the most important, and oftentimes overlooked, fall prevention best practice is analyzing one’s physical environment.6 Reminding clients about the hidden dangers and fall risks present in and around their home may significantly reduce fall risk and prevent life-threatening injuries. Creating an inventory of common environmental risks is a great start!
Are you constantly asking them about their environment and how to make it more safe?
In summary, knowledge is power and consistency is key when it comes to fall prevention. While it is paramount to create safe and effective cardiovascular, strength, balance and flexibility programs, it is equally important to address factors such as proprioception, brain health, hydration and environment? The time is now to educate yourself to best help “fall proof” your clients!
Christine M. Conti, M.Ed, BA is and international fitness educator and presenter. She currently sits on the MedFit Education Advisory Board and has been nominated to be the 2020 MedFit Network Professional of the Year. She is the author of the MedFit Classroom Arthritis Fitness Specialist Course and is the CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation. Christine is also the co-host of Two Fit Crazies & A Microphone Podcast and the co-owner of TFC Podcast Production Co. She is also the best-selling author of SPLIT-SECOND COURAGE.
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Consistent exercise and physical activity may be the closest thing we have to the “fountain of youth” in our society today. Dr. Michael Roizen, author of “The RealAge Workout”, cites studies on identical twins that show genetic inheritance influences only about 30% of the rate and way one ages – the rest is up to you!
Cultivate connections and build relationships within your professional field. There are enough clients and work to go around for all of us. Consider how collaborating with other professionals in your area or the periphery of your field may make you better at what you do. We are better when working together, and I believe our clients are better off.
As a Fitness professional working in the collegiate realm, this has been of the utmost importance to me and my career. Collaborating on a team to produce the best product has been a great learning experience. And let’s face it, when we work together, it expounds upon the individual ideas and makes them grander. We also get the opportunity to hear other points of view and fresh ideas.
Being able to draw on the knowledge of others is an immeasurable way to learn and grow in your area of expertise. The benefits of mentoring and being mentored by others are also invaluable. Think back to who has mentored you in your profession. How has that experience shaped your practice today? How can you pour into others to share your knowledge?
As a personal trainer, I try to build relationships with other professionals in my area. There will come a time in your career when a client presents with an issue outside your scope of practice. Having a list of reliable professionals, you can refer for your client is wonderful. This often yields better results for the client than searching the internet for a provider. And yes, I even have relationships with other trainers. Not every trainer is suitable for every person. Here is a list of the health professionals I have built relationships within my area.
It has been one of my greatest privileges to work alongside a Physical therapist (PT) to graduate a client from PT to Personal training. I have learned so much about injuries and rehab and have built trusted relationships that I can refer my clients to, AND I have been referred to by those professionals as well.
An important caveat; work within your scope of practice. If the opportunity arrives to work with another health professional, obtain the proper RFI or Request For Information. This document says that the client/patient has permitted the two professionals to share information on that person. Abiding by all HIPA laws and regulations, use this information to help bring the client/patient to better whole health.
I know that what I offer as a personal trainer is not the only thing my clients need in their life for whole-body health. Sometimes possibly combining massage with our workouts is what brings their bodies to better health. Another example is counseling. It may be that the stress in life is making it more difficult for my client to reach their full potential; talk therapy may make the physical workout more productive.
If we keep in mind, as health professionals, that we are working toward the whole-body health of our clients/patients, this style of practice is not complex. If we are honest, it is the same for us. Complete whole-body health has many different facets.
Cultivate, Build, and Grow!
Shannon Briggs is a multi-passionate fitness professional and educator. She brings 30-plus years of experience to a long, fulfilling career in the fitness industry. In the past 13 years at the University of Texas at Austin, Shannon has led continuing education workshops in multiple group fitness formats and topics specific to personal training; she also has written the curriculum and manuals for numerous workshops accredited by the American Council on Exercise (ACE). Shannon is currently a monthly contributor to Campus Rec Magazine for Fitness and Wellness.
Nearly 8 million individuals in the US currently have a diagnosable eating disorder. Though that is a big number, it’s not big enough to guarantee that everyone reading this knows someone who is impacted.
Here’s the thing, that number DOES NOT include those with more subtle disordered eating symptoms. This broadens the scope quite a bit.
What if we looked at diagnosable eating disorders as the far end of a spectrum?
Let’s call the other end, healthy intuitive eating.
What does that mean? Healthy intuitive eating means that you eat when you are hungry. It also means that you eat what you are hungry for, and you stop when you feel satisfied.
There are people that fall on that far end. Truly. I have even met one or two! They are not unicorns- possibly the closest living things though.
Let’s label everything in the middle as “disordered eating”. This would include behaviors like overeating, food restricting, skipping meals, over-exercising, overly rigid eating schedules and so many more.
The majority of people, that I know anyway, lie somewhere in that space. Would you agree? Where do you fall?
The big difference between eating disorders and disordered eating is that the latter is typically not lethal and is not all-encompassing.
The big similarity is that more often than not, individuals impacted have a poor body image.
Body image is how you see yourself when you look in the mirror or when you picture yourself in your mind. It encompasses:
Many of us internalize messages starting at a young age that can lead to either positive or negative body image. Let’s clarify what that means.
Positive body image is a clear, true perception of your shape; seeing the various parts of your body as they really are. Body positivity involves feeling comfortable and confident in your body, accepting your natural body shape and size, and recognizing that physical appearance says very little about one’s character and value as a person.
A negative body image, on the other hand, involves a distorted perception of one’s shape. Negative body image involves feelings of shame, anxiety, and self-consciousness. Those with negative body image are constantly comparing themselves to others without recognizing that they are essentially comparing apples to bananas… oranges aren’t far enough away… In such comparisons, they determine their perceived self-worth or value.
As with disordered eating, body image concerns can affect most of us. Recognizing the positive in our bodies can have a huge impact on both of these things. When you are stuck in a spiral of negative self talk, try thinking about things that your body can do. It is easy to judge your looks by looking through unrealistic lenses, but what if you took a moment to appreciate the amazing machine that you possess.
Karli Taylor is an entrepreneur and leader passionately working to shape the nation’s fitness and wellness industry through innovative programming that can be incorporated into any lifestyle. Karli has been in the industry for over 20 years. Beginning as a group exercise instructor and personal trainer, she worked her way to an executive position at a fitness chain in the northeast where she worked behind the scenes for 5 years, until her love of teaching drove her to leave the corporate office for the gym floor. She is the co-founder and creator of BarreFlow, through which she certifies fitness professionals around the globe.
In America today, 40% of females, including women, children and teens, suffer in silence with either primary or secondary dysmenorrhea every month. Primary dysmenorrhea accompanies the monthly menstrual cycle without any underlying medical conditions. Secondary dysmenorrhea means that there is another medical issue present, such as endometriosis. This condition makes it hard to function, with most women being bedridden for three to five days or longer. Dysmenorrhea is not a weakness, but a real medical issue.
Generally, the female client will have severe throbbing pain from the waist down. They can feel it in their stomach, low back, legs and feet, making it hard to move. Other symptoms include nausea, vomiting, diarrhea, anxiety, stress, depression, lightheadedness, fatigue, headache, fever, and depression, weakness and fainting. Risk factors are smoking, obesity, being underweight, strong family history, high levels of stress, anxiety and/or depression. Women can still have painful stomach cramping well after menopause if they have Endometriosis.
This is a silent stressor for many women because they rarely choose to speak about it. Some have been living with the pain for twenty years or more and think there is nothing they can do. If a client comes to you and mentions that they have a lot of pain, urge them to see their doctor. This conversation is more likely to happen with a female personal trainer. The good news is that fitness professionals can help their clients to feel better during this painful time of the month.
It is important to acknowledge this painful condition because of the physical and mental implications that come along with it. As the trainer you, may be working with a therapist as well as an OB/GYN. You are trying to help your client feel better overall. We recommend scheduling an assessment first to understand the client’s medical history. As a fitness professional, you may want to refer your clients to other professionals as well. Acupuncture, for example, is well known for helping women to ease and reduce anxiety. When you network with other professionals, you form a referral system to obtain more clients for yourself, too.
After completing your assessment, you will develop a wellness program for your client. The program will include: exercise, meditation (specific to this condition), and aromatherapy, as well as other components. Try to have your client establish a regular daily wellness routine. Journaling is also important as it helps to connect your thoughts, feelings and behaviors. Support groups can also help as women share their experiences with others.
Robyn Kade is the President/CEO of The Stress Management Institute for Health and Fitness Professionals™ and the SMI Business Institute™. Robyn received her Bachelor’s Degree from Rowan University in Health Promotion and Fitness Management. She is an American Council on Exercise (ACE) personal trainer and group fitness instructor, received a certificate in PTSD through the Kew Training Academy, and is a Compassion Fatigue Resiliency and Recovery – Educator. Robyn is also certified through the American College of Sports Medicine for Exercise Is Medicine (EIM) Level 1. Robyn is currently pursuing her Master’s Degree in Wellness and Lifestyle Management with a concentration on Wellness Coaching at Rowan University.
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To minimize injuries and subsequent negligence claims/lawsuits, exercise professionals need to be aware of their many legal duties and risk management responsibilities. When faced with a negligence lawsuit, courts will determine the standard of care (or duty) of an exercise professional. If the court finds that the exercise professional breached a duty and the breach of duty caused harm to the plaintiff (injured party), the exercise professional (and the professional’s employer) may be found negligent and, thus, liable for the plaintiff’s harm and will need to pay monetary damages. The damages can be in the millions of dollars. For example, the jury awarded the plaintiff $14,500,000 in Vaid v. Equinox (1).
Legal scholar, the late Betty van der Smissen, stated: “if one accepts responsibility for giving leadership to an activity or providing a service, one’s performance is measured against the standard of care of a qualified professional for that situation” (2, p. 40).
A “qualified” professional possesses proper credentials and is competent. A competent exercise professional knows how (has the knowledge and practical skills) to design and deliver a “safe” and “effective” exercise program.
As described by van der Smissen,“for that situation” is determined by reference to the following three factors:
The professional must be aware of the skills and abilities the participant needs to participate “safely” in the activity, e.g., the exercise professional must possess adequate knowledge and skills to lead “reasonably safe” exercise programs.
Example: Exercise professionals that lead exercise programs that are considered “advanced” that can increase the risk of injury (e.g., Olympic lifting, high intensity programs) need to have advanced knowledge and skills necessary to safely lead these types of programs, i.e., they need to be fully informed of precautions that must be taken.
The professional must be aware of individual factors of the participant, e.g., medical conditions that impose increased risks and know how to minimize those risks.
Example: Exercise professionals that design/deliver exercise programs for individuals with medical conditions (e.g., pregnancy, diabetes, back problems) need to possess credentials and competence in clinical exercise by completing clinical academic coursework/education as well as obtaining clinical certifications and experience (3). From a legal liability perspective, it is essential that exercise professionals fully understand any additional or unique risks the medical conditions(s) might impose and how to minimize those risks. In Bartlett v. Push to Walk (4), the court stated:
Programs like Push to Walk “May impose particular duties that an ordinary health club would not have…What would constitute…negligence would differ between an ordinary health club and a facility like Push to Walk” (p. 7).
The professional must be aware of any conditions that may increase risks, e.g., weather conditions such as heat/humidity, floor surfaces, exercise equipment, and know how to minimize those risks.
Example: Exercise professionals need to have the necessary knowledge and skills to properly implement important safety precautions to help prevent heat injuries. Knowing and implementing precautions to minimize risks associated with slippery floor surfaces and improper maintenance of equipment is also important.
A personal trainer had a client, Levy with known osteoporosis, perform a series of jump repetitions on a BOSU ball. After a few reps, she lost her balance and fell fracturing her wrist that required surgery to have a plate and screws inserted into her wrist. She filed a negligence lawsuit against the defendant facility.* The facility filed a motion for summary judgment (request to dismiss the case). Trial court granted the defendant’s motion, and the plaintiff appealed. Upon the appeal, the appellate court reversed the trial court’s ruling. The court stated that the trainer, knowing Levy had osteoporosis, unreasonably increased the risk of harm to her by having her perform an advanced exercise. The appellate court considered the nature of the activity (jumping repetitions on a BOSU ball) and the type of participant (client with osteoporosis) and determined that the exercise professional did not meet the standard of care for that situation.
*In a negligence lawsuit, in addition to the exercise professional, the fitness facility is also named as a defendant through a legal principle called respondeat superior, in which the employer can be vicariously liable for the negligent acts of its employees.
Meeting the standard of care when prescribing exercise for individuals with medical conditions begins by exercise professionals obtaining the necessary credentials and competence. It was obvious that the trainer in the Levy case did not have the necessary knowledge and skills to prescribe a safe and effective program for a client with osteoporosis. The trainer failed to take important precautions to minimize the risk of a fall.
Information provided in this article comes from: Law For Fitness Managers and Exercise — the only comprehensive resource for fitness managers and exercise professional who want to: PROTECT THEMESELVES, THEIR BUSINESS, AND THEIR CLIENTS! For education programs that accompany the text, go to: Educational Courses (fitnesslawacademy.com)
JoAnn M. Eickhoff-Shemek, Ph.D., FACSM, FAWHP, professor emeritus, Exercise Science at the University of South Florida and president of the Fitness Law Academy, LLC, is an internationally known author and speaker. For more than 35 years, her teaching and research have focused on fitness safety, legal liability, and risk management issues. Dr. Eickhoff-Shemek is the lead author of a comprehensive legal/risk management text, Law for Fitness Managers and Exercise Professionals, and is the co-author of another textbook, Rule the Rule of Workplace Wellness Programs, published in 2020 and 2021, respectively.
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